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depression

Nov 05, 2007 - 1 comments
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pregnant



i have a question about a med. Its lexapro. i was wondering if u can get pregnant while u are on it.  if so what do i have to do.

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242516 tn?1368227505
by Enoch Choi, MDBlank, Nov 05, 2007
lexapro is escitalopram.
according to these 2 authors:
Shalia Misri, MD, FRCPC
Shari I Lusskin, MD, FAPA

"Data from five studies including a total of over 1000 early pregnancy citalopram exposures did not find a significantly increased risk of any congenital malformation in the drug exposed group compared to the expected rate in the general population [37,38,43,44,51]. However, use of citalopram was associated with an increased risk of the pooled group of birth defects (comprising anencephaly, omphalocele, and craniosynostosis) [43]. Further studies are needed to clarify the association. As with other agents, we do not recommend switching to another medication if the patient becomes pregnant while taking citalopram.

There are no data on the effects of isolated exposure to escitalopram, which is the s-enantiomer of citalopram (a racemic mixture), although a single case report described necrotizing enterocolitis in an infant exposed during pregnancy and through breastfeeding [52]. The safety data on citalopram are considered to be applicable to escitalopram."

37
TI Delivery outcome after the use of antidepressants in early pregnancy.
AU Ericson A; Kallen B; Wiholm B
SO Eur J Clin Pharmacol 1999 Sep;55(7):503-8.

OBJECTIVES: To investigate delivery outcome after the use of antidepressants in early pregnancy.METHODS: Using an ongoing prospective recording of drug use in early pregnancy, 969 women were identified who reported the use of antidepressants: 531 used only SSRI (selective serotonin re-uptake inhibitor) drugs (mostly citalopram, 375 exposures), 423 used only other antidepressants, and 15 used both. Outcome was compared with all births in the population. RESULTS: Women using these drugs were older and smoked more than three times as often as other women. There seemed to be an excess of high parity women. The frequency of multiple births was lower than expected, resulting from too few twin births in women who had used SSRI. Gestational duration among singletons was shorter but it did not affect infant survival and was similar after the use of SSRI or non-SSRI antidepressants, perhaps the result of uncompensated for confounding or related to the underlying disease. Infants were somewhat heavier than expected, notably after non-SSRI treatment. No increase was seen in congenital abnormalities, observable in the perinatal period.CONCLUSIONS: Based on this database, the use of antidepressants in early pregnancy does not seem to carry any significant risk for the infant that is detectable during the newborn period.

AD Centre for Epidemiology, National Board of Health, Stockholm, Sweden.
PMID 10501819
38
TI Risks associated with selective serotonin reuptake inhibitors in pregnancy.
AU Malm H; Klaukka T; Neuvonen PJ
SO Obstet Gynecol 2005 Dec;106(6):1289-96.

OBJECTIVE: To study the effects of selective serotonin reuptake inhibitors (SSRIs) on pregnancy outcome. METHODS: We performed a population-based study of women exposed to SSRIs during pregnancy (n = 1782). Data were derived from a national project in Finland, established by 3 governmental organizations. In that project, the Drug Reimbursement Register, the Medical Birth Register, the Register of Congenital Malformations, and the Register of Induced Abortions have been linked. Comparisons were made between women with SSRI purchases to matched controls and between women with purchases in different trimesters. Only singleton pregnancies were included. Primary outcomes were major malformations, preterm birth, small for gestational age, low birth weight, and treatment in neonatal special or intensive care unit. Analyses were based on logistic models. RESULTS: Major malformations were not more common in infants or fetuses of women with first trimester SSRI purchases (n = 1,398) when compared with controls with no drug purchases (P = .4). Of infants born to mothers with SSRI purchases in the 3rd trimester, 15.7% were treated in special or intensive care unit compared with 11.2% of infants exposed only during the 1st trimester (P = .009, adjusted odds ratio 1.6, 95% confidence interval 1.1-2.2). We found no increased risk of preterm birth (< 37 weeks), birth 32 weeks of gestation or less, small for gestational age, or low birth weight in women with purchases in each trimester or during the 2nd and 3rd trimesters when compared with women with only 1st trimester purchases CONCLUSION: Use of SSRIs during pregnancy is not independently associated with increased risk of adverse perinatal outcome other than need for treatment in neonatal special or intensive care unit. LEVEL OF EVIDENCE: II-2.

AD Teratology Information Service, HUSLAB, Helsinki University Central Hospital; Social Insurance Institution, Helsinki, Finland; and Department of Clinical Pharmacology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
PMID 16319254
43
TI Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects.
AU Alwan S; Reefhuis J; Rasmussen SA; Olney RS; Friedman JM
SO N Engl J Med. 2007 Jun 28;356(26):2684-92.

BACKGROUND: Information regarding the safety of selective serotonin-reuptake inhibitors (SSRIs) in human pregnancy is sparse. Concern has been raised about the risk of congenital heart defects associated with the use of SSRIs in pregnancy. METHODS: We obtained data on 9622 case infants with major birth defects and 4092 control infants born from 1997 through 2002 from the National Birth Defects Prevention Study. Case infants were ascertained through birth-defects surveillance systems in eight U.S. states; controls were selected randomly from the same geographic areas. Mothers completed a standardized telephone interview regarding exposure to potential risk factors, including medications, before and during pregnancy. Exposure to SSRIs was defined as treatment with any SSRI from 1 month before to 3 months after conception. Birth defects were assigned to 26 categories and subcategories. RESULTS: There were no significant associations between maternal use of SSRIs overall during early pregnancy and congenital heart defects or most other categories or subcategories of birth defects. Maternal SSRI use was associated with anencephaly (214 infants, 9 exposed; adjusted odds ratio, 2.4; 95% confidence interval [CI], 1.1 to 5.1), craniosynostosis (432 infants, 24 exposed; adjusted odds ratio, 2.5; 95% CI, 1.5 to 4.0), and omphalocele (181 infants, 11 exposed; adjusted odds ratio, 2.8; 95% CI, 1.3 to 5.7). CONCLUSIONS: Maternal use of SSRIs during early pregnancy was not associated with significantly increased risks of congenital heart defects or of most other categories of birth defects. Associations were observed between SSRI use and three types of birth defects, but the absolute risks were small, and these observations require confirmation by other studies.

AD Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.
PMID 17596602
44
TI First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects.
AU Louik C; Lin AE; Werler MM; Hernandez-Diaz S; Mitchell AA
SO N Engl J Med. 2007 Jun 28;356(26):2675-83.

BACKGROUND: The risk of birth defects after antenatal exposure to selective serotonin-reuptake inhibitors (SSRIs) remains controversial. METHODS: We assessed associations between first-trimester maternal use of SSRIs and the risk of birth defects among 9849 infants with and 5860 infants without birth defects participating in the Slone Epidemiology Center Birth Defects Study. RESULTS: In analyses of defects previously associated with SSRI use (involving 42 comparisons), overall use of SSRIs was not associated with significantly increased risks of craniosynostosis (115 subjects, 2 exposed to SSRIs; odds ratio, 0.8; 95% confidence interval [CI], 0.2 to 3.5), omphalocele (127 subjects, 3 exposed; odds ratio, 1.4; 95% CI, 0.4 to 4.5), or heart defects overall (3724 subjects, 100 exposed; odds ratio, 1.2; 95% CI, 0.9 to 1.6). Analyses of the associations between individual SSRIs and specific defects showed significant associations between the use of sertraline and omphalocele (odds ratio, 5.7; 95% CI, 1.6 to 20.7; 3 exposed subjects) and septal defects (odds ratio, 2.0; 95% CI, 1.2 to 4.0; 13 exposed subjects) and between the use of paroxetine and right ventricular outflow tract obstruction defects (odds ratio, 3.3; 95% CI, 1.3 to 8.8; 6 exposed subjects). The risks were not appreciably or significantly increased for other defects or other SSRIs or non-SSRI antidepressants. Exploratory analyses involving 66 comparisons showed possible associations of paroxetine and sertraline with other specific defects. CONCLUSIONS: Our findings do not show that there are significantly increased risks of craniosynostosis, omphalocele, or heart defects associated with SSRI use overall. They suggest that individual SSRIs may confer increased risks for some specific defects, but it should be recognized that the specific defects implicated are rare and the absolute risks are small.

AD Slone Epidemiology Center at Boston University, Boston, MA 02215, USA. clouik @ slone.bu.edu
PMID 17596601
51
TI Citalopram use in pregnancy: prospective comparative evaluation of pregnancy and fetal outcome.
AU Sivojelezova A; Shuhaiber S; Sarkissian L; Einarson A; Koren G
SO Am J Obstet Gynecol 2005 Dec;193(6):2004-9.

OBJECTIVE: Citalopram is a selective serotonin reuptake inhibitor indicated for depression. The safety of this medication in pregnancy has not been fully established. The purpose of this study was to investigate whether citalopram is associated with an increased incidence of adverse pregnancy outcomes. STUDY DESIGN: Pregnant women who contacted the Motherisk Program, a Teratogen Information Center in Toronto, Ontario, with regard to the safety of citalopram in pregnancy were enrolled in the study. The exposed women were matched to a disease-matched group of women and a nonteratogenic group. All women were matched for age (+/- 2 years) and gestational age at time of first call to the Motherisk (+/- 2 weeks). A structured telephone follow-up interview was conducted following the expected date of confinement. RESULTS: The total number of pregnant women enrolled in this study was 396 (132 women in each group). A total of 125 women took citalopram at least in the first trimester. Seventy-one (54%) women continued to take the drug throughout pregnancy. One hundred fourteen women (86%) had live births, 14 (11%) had spontaneous abortions, 2 (1.5%) had elective terminations, and 2 (1.5%) experienced stillbirths. Fetal survival rates, mean birth weights, and duration of pregnancy were not statistically different among the 3 groups. Of 108 live-born infants whose mothers were exposed to citalopram in the first trimester, there was 1 (0.9%) male infant born with a major malformation. There was a relative risk of 4.2 (95% confidence interval 1.71-10.26) in neonates exposed to citalopram close to term to be admitted to special-care nurseries as compared with the unexposed infants. CONCLUSION: Citalopram use during the period of embryogenesis in pregnancy is not associated with an apparent major teratogenic risk. Late pregnancy use of citalopram is associated with increased risk of poor neonatal adaptation syndrome, recently described with other selective serotonin reuptake inhibitors.

AD The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Ontario, Canada. anutik @ canada.com
PMID 16325604

52
TI Necrotizing enterocolitis associated with in utero and breast milk exposure to the selective serotonin reuptake inhibitor, escitalopram.
AU Potts AL; Young KL; Carter BS; Shenai JP
SO J Perinatol. 2007 Feb;27(2):120-2.

A term neonate presenting with necrotizing enterocolitis following in utero and breast milk exposure to the newest serotonin selective reuptake inhibitor, escitalopram, is described.Journal of Perinatology (2007) 27, 120-122. doi:10.1038/sj.jp.7211640.

AD 1Department of Pharmacy, Vanderbilt Children's Hospital, Nashville, TN, USA.
PMID 17262045

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